What Are Chronic Ear Infections?

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When an ear infection does not go away or keeps coming back, it is called a chronic ear infection. It often involves a hole in the eardrum, the tissue that separates the outer ear and middle ear, that does not heal.

There are three common types of ear infections, but the one that affects the middle ear, known as otitis media, is the most common. The middle ear is the space behind the eardrum. It can become infected if the eustachian tube, which drains fluids from the middle ear, becomes blocked. The buildup can apply pressure on the eardrum, which can result in earache.

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What Is a Chronic Ear Infection? 

A chronic ear infection can be caused by an acute ear infection that does not completely go away or repeat ear infections. Acute otitis media is one of the most common types of ear infections. It can become chronic. Otitis media with effusion (a buildup of fluid), which typically occurs in children, can also become chronic.

Otitis media with effusion can occur after an infection has cleared up but fluid remains trapped in the middle ear. When it becomes chronic, it is referred to as chronic chronic otitis media with effusion (COME).

Acute otitis media can also lead to chronic suppurative otitis media (CSOM), in which ear discharge does not go away or it keeps coming back. CSOM is considered a complication of a middle ear infection. The discharge in CSOM continues to leak out through a hole in the eardrum.

Symptoms

While ear infections are incredibly common, they tend to heal fairly quickly. To be considered chronic, the symptoms have to last for at least three months.

The problem with chronic ear infections is that they don't always present with the same symptoms as an acute ear infection, or the symptoms are much milder. Because of this, many people are unaware that they have a chronic ear infection. The symptoms of a chronic ear infection can include:

  • Mild ear pain or discomfort
  • Pressure in the ear
  • Low-grade fever
  • Pus drainage from the ear
  • Hearing loss

If a young child or infant has a chronic ear infection, they will likely have these signs of discomfort:

  • Difficulties with learning
  • Pulling or tugging at the ears
  • Irritability
  • Speech delay
  • Difficulty feeding or eating

Ear Infections Doctor Discussion Guide

Doctor Discussion Guide Child

Diagnosis

The diagnostic process will typically involve various tests to examine the eardrum in greater detail. Your primary care physician will look into the affected ear with an otoscope, a small medical device that shines a light into the ear and helps the doctor view the ear canal and eardrum. They will look for:

  • Redness
  • Air bubbles
  • Thick fluid buildup
  • An eardrum that is sticking to the bones of the middle ear
  • Fluid that is draining from the middle ear
  • A hole in the eardrum
  • A bulging eardrum or a collapsed eardrum (when the eardrum is pulled inward)

A culture may also be required to see if the infection is caused by bacteria, viruses, or fungi. A CT (computed tomography) scan may be required to investigate whether the infection has spread and if any damage was caused in other parts of the head. If hearing loss is one of the symptoms, hearing tests may also be conducted.

When to See a Doctor

Following treatment for an ear infection, you should keep an eye on the return of any symptoms, no matter how mild, and whether the infection doesn't seem to clear up. If symptoms return or remain, you should see your doctor.

Treatment

Treatment for a chronic ear infection depends on what is causing it. For example, if bacteria are to blame, antibiotics will be prescribed. If the cause is a hole in the eardrum, surgery may be needed.

Medications

Antibiotics are the first-line treatment for chronic ear infections caused by bacteria. If the infection is caused by a fungus, topical antifungal medications will be prescribed. Antibiotics are available as capsules or ear drops.

For children with chronic bacterial ear infections, liquid antibiotics may be prescribed. The most common antibiotics used are amoxicillin or penicillin. Some research suggests that ear drops containing both an antibiotic and a corticosteroid, which can reduce inflammation, are highly effective for treating chronic ear infections.

Ear drops are typically the first-line treatment for a hole in your eardrum. These ear drops may contain antibiotics.

Surgeries and Specialist-Driven Procedures

If there is damage to the eardrum or the small bones in the middle ear, surgery may be needed. Surgery to repair a hole in the eardrum is known as tympanoplasty.

If the infection has spread to the mastoid bone, which sits behind the ear, a mastoidectomy may be performed. Since the mastoid bone contains small air pockets, the infection can spread into these pockets and cause the bone to break down. A mastoidectomy removes the infected material from those spaces.

If your chronic ear infection results from recurrent infections in your nose, mouth, or throat, an adenoidectomy may be needed. This procedure removes the adenoids, which are glands above the roof of the mouth, at the back of the nose, that fight infections. When these adenoids become inflamed, they can cause fluid buildup in the ear. Research has shown that adenoidectomies may be the best way to manage chronic ear infections in children.

Ear tube surgery is another treatment option often used for children with chronic ear infections. The surgery involves placing tubes in the eardrum so that airflow is restored. The added airflow evens out the pressure on both sides of the eardrum so fluid can drain from the ear properly.

Can Adults with Chronic Ear Infections Get Ear Tubes?

Although the procedure is usually performed in children, ear tube surgery is available to adults with chronic ear infections if their infections are caused by persistent fluid buildup behind the eardrum.

Complications

Chronic ear infections can lead to complications if left untreated, which can include:

  • Mastoiditis (bacterial infection of the mastoid bone)
  • Fistulas (abnormal connections between two body parts, including parts within the ear)
  • Muscle weakness or paralysis in the face, known as facial palsy
  • An inner ear infection (otitis interna)
  • Swelling of membranes around the brain and spinal cord, known as meningitis
  • A brain abscess (pus-filled swelling)
  • Inflammation of the inner walls of the sinuses that can lead to blood clots 
  • Hearing loss
  • A cyst (fluid-filled sac) in the middle ear, known as a cholesteatoma
  • Hardening of tissue in the middle ear
  • Continuous drainage from the hole in the eardrum

Summary

A chronic ear infection is one that does not go away, or it keeps coming back. It typically involves a hole in the eardrum that does not heal, and fluid buildup and swelling in the middle ear. It can be caused by an acute ear infection that does not go away completely or repeat ear infections. Symptoms can include ear pain, fever, pus-like drainage from the ear, and hearing loss.

A Word From Verywell

Having a chronic ear infection can be difficult to cope with, especially if you have tried several treatment options and have yet to find relief. The good news is that as soon as you find the right treatment, you will be able to clear up the infection and prevent any further complications or permanent damage.

If you are at risk of developing chronic ear infections or have had an ear infection recently, the best thing you can do is keep an eye on any symptoms. If symptoms continue or get worse, or if the infection returns, get treatment promptly. To help prevent an ear infection from occurring, clean your ears properly using a cloth and wash your hands regularly to avoid coming into contact with bacteria, fungi, or viruses that can cause infection.

Frequently Asked Questions

  • Why does my ear infection keep coming back?

    There is no one reason why an ear infection keeps returning. Some common causes of a recurring ear infection include allergies, chronic sinus infections, a blocked eustachian tube, and frequent infections in the nose, mouth, or throat.

  • How do you treat chronic ear infections?

    Treatment options vary depending on the cause of the chronic ear infection. In many cases, ear drops containing antibiotics will be used if the cause is bacterial. If the cause is a hole in the eardrum, surgery like tympanoplasty may be required to repair the damage.

  • Can an ear infection be a sign of something more serious?

    Although ear infections aren’t typically a sign of an underlying health condition, they could indicate that there is another infection or there is structural damage to your ear tubes. If you experience any signs of an ear infection, you should see a doctor as soon as possible. Getting treatment early will help prevent permanent damage to your ear or other health complications.

  • Can chronic ear infections cause permanent damage?

    Chronic ear infections can cause permanent damage if left untreated. The infection could spread to other parts of the head or cause the eardrum to rupture. Sometimes if a chronic ear infection is left untreated for a long period of time, permanent hearing loss can occur.

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10 Sources
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